RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit II - Care of the Client Requiring Rehabilitation
Behavioral Objectives
1. Discuss the philosophy and specific
issues that are applicable to
rehabilitation nursing.
2. Identify and discuss the
responsibilities of the rehabilitation
team members.
3. Analyze factors included in the
assessment of the client who is enrolled
in rehabilitation center.
Content Outline
I. Rehabilitation
A. Philosophy
B. Specific issues
1. Psychological and
emotional reactions to disability
2. Coping with fatigue
3. Sexuality issues
4. American with Disabilities
Act (ADA)
5. Rehabilitation in the home
and community
C. Tertiary care
II. Rehabilitation Team
a. Client
b. Family
c. Rehabilitation Nurse
d. Physician
e. Physiatrist
f. Psychiatrist & psychologist
g. Physical therapist
h. Occupational therapist
i. Speech-language therapist
j. Social Worker
k. Vocational Counselor
l. Rehabilitation engineer
m. Sex counselor
n. Orthotist/prosthetist
III. Assessment for rehabilitation
A. Developmental considerations
1. Infant
2. Child
3. Adolescent
4. Adult
5. Older adults
Clinical Objectives
Use basic management and
leadership skills, act as a team
leader, supervise and delegate
care and contribute to shared
goals.
Provide nursing care within
limits of professional nursing
knowledge, education,
experience, and ethical/legal
standards of care.
Provide holistic care that
addresses the needs of diverse
individuals across the life span.
Evaluate the learning needs of
self, peers, or others and
intervene to assure quality of
care.
Promote accountability for
quality nursing practice through
participation on policy &
procedure committees.
Delegate/assign to other health
care providers within legal
parameters and evaluate delivery
of care.
Learning opportunities
READ:
Lewis (2007)
Lehne (2010)
VCR:
#M141
Will (if possible) attend a rehabilitation
team meeting during clinical rotation.
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit II - Care of the Client Requiring Rehabilitation
Behavioral Objectives
4.
Content Outline
B. Functional ability assessment
1. Coping patterns
2. Functional ability
3. Mobility
4. Integrity of skin
5. Control of bowel & bladder
function
C. Assessment tools and scales
1. Pulses
2. Barthel Index
3. Functional Independence Measure(FIMS)
4. Activities of daily living(ADL’s)
Discuss analysis, planning
implementation and evaluation for
the nursing management of clients
who are undergoing rehabilitation
3.
IV. Selected nursing diagnoses/implementation and
evaluation
A. Self-care deficit: Activities of daily living
1. Independent interventions
a. Help client identify safe limits
of independent activity
b. Teach, guide, and support the
client learning how to perform
self-care activities
c. Assist with using adaptive/assistive
device (self-help device)
d. Assist with bathing/hygiene,
dressing/grooming, feeding, toileting
e. Assist the client to perform and
practice the activity in real-life
situations
2. Collaborative interventions
a. Collaborate with other members of the
rehabilitation team.
b. Include personal care giver
3. Recognition of complications
a. Non-participation in self-care
b. Family not being able to accept
disability
Clinical Objectives
Learning opportunities
Will complete an analysis on client in
rehabilitation unit using the Functional
Independent Measure (FIMS) tool.
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit II - Care of the Client Requiring Rehabilitation
Behavioral Objectives
Content Outline
c.
Financial problems
4. The client will be able to do own self care
as evidenced by:
a.
Demonstrates independent self-care
in bathing/hygiene or with assistance,
using adaptive devices.
b. Demonstrates independent self-care in
dressing/grooming or with assistance,
using adaptive devices.
c. Demonstrates independent self-care in
feeding or with assistance, using
adaptive devices.
d. Demonstrates independent self-care in
toileting or with assistance, using
adaptive devices.
B. Impaired physical mobility
1. Independent interventions
a.
Positioning
b.
Preventing external rotation of the
hip
c.
Preventing footdrop
d.
Maintaining muscle strength and
joint mobility
e.
Performing range-of-motion
exercises
f.
Performing therapeutic exercises
g.
Promoting independent mobility
h.
Assisting the client with transfer
i.
Preparing for ambulation using
ambulatory aids
j.
Teaching client to ambulate with
crutches, walker, and cane
2. Collaborative interventions
a.
Collaborate with other members of
b.
Rehabilitation team
c.
Include personal care giver
3. Recognition of complications
Clinical Objectives
Learning opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit II - Care of the Client Requiring Rehabilitation
Behavioral Objectives
Content Outline
a. External rotation of hips
b. Footdrop
c. Contractures
d. Inability to ambulate safely
4. The client will have improved
physical mobility as evidenced by:
a. Maintaining muscle strength and
joint mobility
b. Developing contractures
c. Transferring safely
d. Ambulating with maximum
independence
e. Demonstrating an increased activity
tolerance.
C. Impaired skin integrity
1. Independent intervention
a. Relieve pressure
b. Improve mobility
c. Improve sensory perception
d. Improve tissue perfusion
e. Improve nutritional status
f. Reduce friction and
shearing forces
g. Minimize moisture
h. Promote pressure ulcer healing
2. Collaborative interventions
a.
Collaborate with members of the
Rehabilitation team.
b. Include personal care giver.
c.
Chronic wound management
3. Recognition of complications
a.
Pressure ulcers
1) Stage I
2) Stage II
3) Stage III
4) Stage IV
Clinical Objectives
Learning opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit II - Care of the Client Requiring Rehabilitation
Behavioral Objectives
Content Outline
4. The client will exhibit intact skin integrity
as evidenced by:
a.
Exhibiting no area of blanchable
arrhythmia at bony prominence
b. No breaks in the skin.
c.
Adequate tissue perfusion.
d. Attaining/maintaining adequate
nutritional status.
e.
Experiences healing of pressure ulcer
D. Altered elimination patterns: urinary/bowel
1. Independent interventions
a.
Promote urinary continence
1) Bladder training
2) Habit training
3) Biofeedback
4) Pelvic floor exercises
5) Clean intermittent catheterization
6) Indwelling catheter
7) External catheter
b.
Start client on bowel training program
c.
Prevent constipation
2. Collaborative interventions
a.
Refer to dietician
1) High fiber diet
2) Natural stimulants
3) Increase fluids
Clinical Objectives
Learning opportunities
RNSG 2414 – Integrated Care of the Client with Complex Health Care Needs
Unit II - Care of the Client Requiring Rehabilitation
Behavioral Objectives
Content Outline
Administer medications and monitor
for desired effects/adverse/side effects
1) Rectal suppositories
2) Stool softeners
3) Bulk-forming agents
4) Mild stimulants
c.
Collaborate with members of
the rehabilitation team
d. Include personal care giver
3. Recognition of complications
a. Bladder infection
b. Fecal impaction
c. Urinary incontinence
d. Bowel incontinence
4. The client will exhibit control over
bowel/bladder as evidenced by:
a. No episodes of incontinence.
b. No episodes of constipation.
c. No bladder infection.
d. Achieving independence in toileting.
Clinical Objectives
Learning opportunities
b.
N:Spring\RNSG 2414 Unit II Rehab Client
Reviewed 06/11